Factores determinantes de una baja dosis de hemodiálisis establecida por dialisancia iónica en pacientes críticos con insuficiencia renal aguda

background: estimating the dialysis dose is a requirement commonly used to assess the quality of renal replacement therapy (rrt) in patients with chronic kidney disease (ckd). in patients with acute kidney injury (aki), this value is not always evaluated and it has been estimated that the prescribed dose is seldom obtained. reports addressing this issue in aki individuals are scarce and most have not included an adequate number of patients or treatments, nor were patients treated with extended therapies. kt values obtained by the ionic dialysance method have been validated for the evaluation of the dialysis dose and it has also been shown that, compared with kt/v, this is the most sensitive strategy for revealing inadequate dialysis treatment in critically ill aki individuals. the main aim of this study was to assess the difference between the prescribed and the administered dialysis dose in critically ill aki patients, and to evaluate what factors determine this gap using kt values assessed through ionic dialisance. material and method: data from 394 sessions of renal replacement therapy in 105 adult haemodialysis (hd) patients with oliguric acute kidney injury and admitted to icu were included in this analysis. rrt was carried out with fresenius 4008e dialysis machines equipped with on-line clearance monitoring (ocm？ fresenius), which use non-invasive techniques to monitor the effective ionic dialysance, equivalent to urea clearance. the baseline characteristics of the study population as well as the prescription and outcome of rrt were analysed. these variables were included in a multivariate model in which the dependent variable was the failure to obtain the threshold dose (td). results: the main baseline characteristics of the study population/treatments were: age 66±15 years, 37% female, most frequent cause of aki: sepsis (70%). low bp and/or vasoactive drug requirement (71%), mechanical ventilation (70%) and average individual severity index: 0.7±0.26. two hu